Dynamic Pituitary MRI has High Sensitivity and Specificity for the Diagnosis of Mild Cushing's Syndrome and should be Part of the Initial Workup

Friedman, Theodore C.; Zuckerbraun, E.; Lee, M. L.; Kabil, Mohamed S; Shahinian, Hrayr K.

doi:10.1055/s-2007-980192

Cited by 85 publications

(41 citation statements)

References 20 publications

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“…In a recent review, Raff reported that measurement of an elevated late-night SC has a O90% sensitivity and specificity for the diagnosis of CS (11), while a recently published meta-analysis on SC measurement in CS took into account only seven studies that contained sufficient information to be processed (10). A total of 339 patients with CS revealed for SC a pooled sensitivity of 92% and a specificity of 96% (5,21,22,23,24,25,26). In our series, a cutoff of 2.77 ng/ml for MSC obtained a sensitivity of 100% to identify patients with CD untr and a specificity of 97.7% in the controls, the results being similar to those described in the literature (5,7,20,21,22,23,24,25,26,27,28,29,30,31).…”

Section: Discussionmentioning

confidence: 99%

“…A total of 339 patients with CS revealed for SC a pooled sensitivity of 92% and a specificity of 96% (5,21,22,23,24,25,26). In our series, a cutoff of 2.77 ng/ml for MSC obtained a sensitivity of 100% to identify patients with CD untr and a specificity of 97.7% in the controls, the results being similar to those described in the literature (5,7,20,21,22,23,24,25,26,27,28,29,30,31). More limited data are available regarding the determination of SC after the DST and not always as reliable as MSC (22,28,31,32,33).…”

Section: Discussionmentioning

confidence: 99%

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Usefulness of salivary cortisol in the diagnosis of hypercortisolism: comparison with serum and urinary cortisol

Manetti¹,

Rossi²,

Grasso³

et al. 2013

European Journal of Endocrinology

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Objective: Several tests have been proposed to diagnose patients with Cushing's syndrome (CS). The aims of the study were: i) to evaluate the performance of salivary cortisol (SC) in hypercortisolism and ii) to compare SC with serum cortisol (SeC) and urinary cortisol. Design and patients: This was a diagnostic study. Twenty-seven patients with untreated Cushing's disease (CD untr), 21 women consuming oral contraceptive pill (OCP), 18 pregnant women, and 89 healthy subjects (controls) were enrolled. Methods: SC and SeC at baseline and after the low-dose dexamethasone suppression test (LDDST) and urinary free cortisol (UFC) were measured. Results: Midnight SC had a sensitivity of 100% in the CD untr group and a specificity of 97.7% in the controls. Specificity remained high (95.2%) in women taking OCP, while in pregnant women, it decreased to 83.3%. SC after the LDDST showed a sensitivity of 96.3% in the CD untr group; specificity was 97.7% in the controls and 90.5% in OCP women. Midnight SeC had a sensitivity of 100% in the CD untr group. SeC after the LDDST had a sensitivity of 100% in the CD untr group while specificity was 97.7% in the controls and 61.9% in women taking OCP. For UFC, sensitivity was 92.6% in the CD untr group while specificity was 97.7% in the controls and 100% in the OCP group. Conclusions: SC is a reliable parameter for the diagnosis of severe hypercortisolism, with high sensitivity and specificity. In women during pregnancy or taking OCP, the measurement of SC, identifying the free fraction, could be helpful to exclude CS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Usefulness of salivary cortisol in the diagnosis of hypercortisolism: comparison with serum and urinary cortisol

Manetti¹,

Rossi²,

Grasso³

et al. 2013

European Journal of Endocrinology

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“…Accordingly, more detailed sequences (e.g., dynamic and/or SPGR MRI) are often employed, leading to a reported improvement in sensitivity from 50-55% (SE) to 70-75% (dynamic) and 70-90% (SPGR), but with the important caveat of a high detection rate of incidental pituitary lesions (6,20,21,22). This presents a significant challenge, with the risk that a coincidental pituitary lesion will be erroneously identified as the source of excess ACTH, either in a patient with genuine CD due to a non-visualised microadenoma (illustrative case 5, Fig.…”

Section: European Journal Of Endocrinologymentioning

confidence: 99%

A role for 11C-methionine PET imaging in ACTH-dependent Cushing's syndrome

Koulouri

Steuwe

Gillett

et al. 2015

European Journal of Endocrinology

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Objective: We report our experience of functional imaging with 11 C-methionine positron emission tomography-computed tomography (PET-CT) co-registered with 3D gradient echo (spoiled gradient recalled (SPGR)) magnetic resonance imaging (MRI) in the investigation of ACTH-dependent Cushing's syndrome. Design: Twenty patients with i) de novo Cushing's disease (CD, nZ10), ii) residual or recurrent hypercortisolism following first pituitary surgery (Gradiotherapy; nZ8) or iii) ectopic Cushing's syndrome (nZ2) were referred to our centre for functional imaging studies between 2010 and 2015. Six of the patients with de novo CD and five of those with persistent/relapsed disease had a suspected abnormality on conventional MRI. Methods: All patients underwent 11 C-methionine PET-CT. For pituitary imaging, co-registration of PET-CT images with contemporaneous SPGR MRI (1 mm slice thickness) was performed, followed by detailed mapping of 11 C-methionine uptake across the sella in three planes (coronal, sagittal and axial). This allowed us to determine whether suspected adenomas seen on structural imaging exhibited focal tracer uptake on functional imaging. Results: In seven of ten patients with de novo CD, asymmetric 11 C-methionine uptake was observed within the sella, which co-localized with the suspected site of a corticotroph microadenoma visualised on SPGR MRI (and which was subsequently confirmed histologically following successful transsphenoidal surgery (TSS)). Focal 11 C-methionine uptake that correlated with a suspected abnormality on pituitary MRI was seen in five of eight patients with residual or recurrent Cushing's syndrome following first TSS (and pituitary radiotherapy in two cases). Two patients elected to undergo repeat TSS with histology confirming a corticotroph tumour in each case. In two patients with the ectopic ACTH syndrome, 11 C-methionine was concentrated in sites of distant metastases, with minimal uptake in the sellar region. Conclusions:11 C-methionine PET-CT can aid the detection of ACTH-secreting tumours in Cushing's syndrome and facilitate targeted therapy.

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“…A study by Githinji KJ et al on clinical experience and outcome of pituitary surgery reported mean age of 36.9 + 14.6 years and they also found female preponderance (60.0%) in their study. 15,16 Another study by Seuk JW et al also found a similar age of presentation (42.4 years), however, they found in contrast gender presentation with males in dominance with (72.5%) proportion. 17,18 Gnjidic Z and colleagues reported mean age of 40.1 years ranging from 19 to 65 years.…”

Section: Discussionmentioning

confidence: 85%

Visual Field Defects; The Comparison Before and After Excision of Sella Supra Sellar Tumors by Performing the Pre and Post-Op Computerized Perimetry

Khalid¹,

Aslam²,

Raina³

et al. 2017

TPMJ

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ABSTRACT… Objectives:To obtain and compare the exact visual status before and after excision of sella supra sellar tumors using the computerized perimetry as a standard measuring tools and then compare with the international studies. Background: Sella suprasellar tumors are though not so common but affect visual acuity of patients and their quality of life drops. These tumors include pituitary adenoma commonest in the adult population, meningioma, Craniopharyngioma, astrocytic glioma, Optic nerve Glioma, Germinoma, Dermoid, Pituitary metastases. We planned a descriptive case series study to compare the pre and post excision visual field defects using computerized perimetry. Study Design: Case series study. Setting: Department of Neurosurgery, Pakistan Institute of Medical Sciences, SZABMU, and Islamabad. Period: 2 years from January 2015 to December 2016. Methods: A total of 73 patients with sella suprasellar tumors were identified and enrolled. Patients between the age of 10 and 55 years were selected on the basis of having sella supra sellar tumor on CT/MRI brain with contrast. Patients whose age was less than 10 years and more than 55 years were excluded. Moreover, patients with post radiation necrosis diagnosed on MRI and MR spectroscopy brain, those operated for other eye pathology and patients with sella supra sellar SOL having comorbidities like diabetes mellitus, hypertension etc. were also excluded from the study. The study outcome was measured in terms of comparison of visual field defects after excision of sella suprasellar tumors using computerized perimetry. Results: The average age of patients was 42.1 + 6.8 years ranging from 10 to 55 years. Female gender was predominant; there were 40 (54.8%) female patients. The mean computerized perimetry was 0.65 + 0.34 LogMAR before surgery which improved to 0.19 + 0.12 LogMAR after surgery. Overall, of the 73 cases, 63 (86.4%) had improvement whereas 10 (13.6%) study cases had no improvement in the visual field on follow-up. Conclusion: It can be concluded that after craniotomy and excision of sella suprasellar tumors, perimetry showed improvement in the majority of the study cases. Key words:Sella suprasellar tumors, excision, computerized perimetry, visual field. The comparison before and after excision of sella supra sellar tumors by performing the pre and post-op computerized perimetry. Professional Med J 2017;24(10)

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Dynamic Pituitary MRI has High Sensitivity and Specificity for the Diagnosis of Mild Cushing's Syndrome and should be Part of the Initial Workup

Cited by 85 publications

References 20 publications

Usefulness of salivary cortisol in the diagnosis of hypercortisolism: comparison with serum and urinary cortisol

Usefulness of salivary cortisol in the diagnosis of hypercortisolism: comparison with serum and urinary cortisol

A role for 11C-methionine PET imaging in ACTH-dependent Cushing's syndrome

Visual Field Defects; The Comparison Before and After Excision of Sella Supra Sellar Tumors by Performing the Pre and Post-Op Computerized Perimetry

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